Healthcare in India — Public and Private

Role of the Government in Health

Article 21 of the Indian Constitution guarantees right to life — courts have interpreted this to include the right to health.
The Directive Principles (Article 47) direct the state to improve public health and nutrition.
A healthy person is more productive → health is both a human right and an economic need.

If healthcare is only private:
- Poor people cannot afford treatment → die from curable diseases.
- Doctors concentrate in cities → rural areas have no doctors.
- Profit motive → unnecessary tests and procedures.
The government must provide affordable, accessible healthcare especially for poor and rural citizens.

Three levels:

Level	Facility	What it handles
Primary	Sub-centre, Primary Health Centre (PHC)	Basic care — fever, diarrhoea, maternal care, immunisation
Secondary	District hospital, community health centre	More serious cases, surgery, specialist consultations
Tertiary	AIIMS, PGI, medical colleges	Complex cases, specialised treatment, medical education

Sub-centres cover 3,000–5,000 people (plains) / 1,000–3,000 people (hilly/tribal areas).
PHCs: at least one doctor + staff for 20,000–30,000 population.
In practice: understaffed, under-equipped, underfunded — especially in rural areas.

Problem	Detail
Rural–urban gap	70% population in rural areas; most doctors in cities
Cost	Out-of-pocket spending pushes families into debt
Shortage of doctors	India has 0.7 doctors per 1000 people (WHO recommends 1 per 1000)
Medicines	Essential medicines unavailable at public health centres
Sanitation link	Poor sanitation → disease; government must address together

Small country (population ~5 million) invested heavily in public healthcare.
Free healthcare for all citizens — primary, secondary, tertiary.
Key features:
- Community health workers visit every household regularly.
- Immunisation campaigns; maternal health support.
- Clean water and sanitation linked with health policy.
Result: Life expectancy ~80 years (comparable to USA); infant mortality very low — achieved on a fraction of USA's healthcare spending.
Lesson: Political commitment and universal public provision matter more than wealth.

Scheme	Purpose
Ayushman Bharat – PMJAY	Health insurance cover of ₹5 lakh per family per year for 50 crore poor citizens
Janani Suraksha Yojana	Cash incentive for institutional delivery to reduce maternal mortality
National Immunisation Programme	Free vaccines for children — polio, measles, TB, Hepatitis B
Mid-Day Meal Scheme	School meals improve nutrition and attendance
ASHA workers	Community health workers link rural families to public health system
Jan Aushadhi Kendras	Government shops selling generic medicines at low prices

Universal Health Coverage (UHC): every person gets quality health services without financial hardship.
India needs more investment in public health (currently ~1.3% of GDP; WHO recommends 5%+).
Train more doctors, nurses, ASHA workers; post them in rural areas.
Address social determinants: clean water, sanitation, nutrition → prevent disease before it occurs.

Open the Practice tab for graded questions on Role of Government in Health.